Abstract

PIP: Cesarean hysterectomy is discussed and it shown, through a literature review and Swedish statistics, that it is now a safe procedure and should be considered as a method of sterilization in repeat cesarean sections. The concepts of indicated and elective cesarean hysterectomies were first introduced into the literature in 1958. The former concept applied to cesarean hysterectomies usually done as a life-saving devices, e.g., excessive uterine hemorrhage. The latter kind referred to those done on schedule for benign uterine disease or for sterilization after repeat cesarean section. Elective cesarean hysterectomy has been shown to be used for sterilization just as safely as cesarean section with tubal ligation. A review of morbidity, complication, and mortality rates for hysterectomy, vaginal or abdominal, is presented. It is concluded that: 1) cesarean hysterecomy is as safe a procedure as cesarean section, 2) blood loss is not excessive when compared with tubal ligation, 3) this procedure should not be advocated for sterilization alone when vaginal delivery is a possibility, and 4) this is the safest and best method of choice when sterilization is indicated following repeat cesarean section and when proper patient selection and education is carried out.